Rhabdomyolysis, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Rhabdomyolysis, Diagnosis and Treatment and Related Diseases
Rhabdomyolysis is the decomposition (breakdown) of damaged skeletal muscle.
Muscle breakdown causes the discharge of myoglobin into the bloodstream.
Myoglobin is the protein that stocks up oxygen in the muscles.
If a person has too much myoglobin in the blood, it can cause kidney damage.
This would indicate that the kidneys cannot remove waste and concentrated urine.
Infrequently, rhabdomyolysis can even cause death.

Causes:
1. Trauma or crush injuries
2. Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP
3. Genetic muscle diseases
4. Extremes of body temperature
5. Ischemia or death of muscle tissue
6. Low phosphate levels
Symptoms:
1. Muscle weakness,
2. Myalgias, and
3. Dark urine
Other symptoms:
1. Fatigue
2. Joint pain
3. Seizures
4. Weight gain

Diagnosis:
A physical examination will reveal tender or injured skeletal muscles.

These tests may be raised:
1. Creatine kinase (CK) level
2. Serum calcium
3. Serum myoglobin
4. Serum potassium
5. Urinalysis
6. Urine myoglobin test
Imaging studies normally play small part in the early diagnosis of rhabdomyolysis.
Radiographs should be obtained when fractures are suspected.
Computed tomography (CT) of the head may be required on a case-by-case basis when a patient with an altered sensorium is assessed.
Patients with significant head trauma may need head CT.
A head CT scan may also be done in patients with first-time seizure activity or extended seizures or in patients with neurological deficits of unknown cause.
Magnetic resonance imaging (MRI) may be helpful in differentiating various causes of myopathy.
One study indicates that bacterial myositis, focal myositis, and idiopathic rhabdomyolysis show a typical gadolinium enhancement on MRI.
Other tests:
1. ECG should be done early in the course of evaluation to assess for cardiac dysrhythmias related to hyper-kalemia or hypo-calcemia.
2. The compartment pressures must be measured in any patient with serious focal muscle tenderness and a firm muscle compartment.
A fasciotomy may be required if compartment pressures in excess of 25-30 mm Hg are evident.
Histology reveals necrotic muscle fibers in patients with rhabdomyolysis.
3. A muscle biopsy may be required to show immunohistochemical features of necrosis only if underlying and often inherited muscle disease is a problem.
4. Immunoblotting, immunofluorescence, and genetic studies may be required to find evidence of inflammatory conditions or dystrophinopathies

Treatment:
Medical treatment:
1. The doctor should appraise the ABCs (A irway, B reathing, C irculation) and provide supportive care as needed
2. The doctor should ensure adequate hydration, and record urine output.
3. The doctor should identify and correct the inciting cause (e.g., trauma, infection, or toxins)
Support treatment:
1. Correction of electrolyte imbalances
2. Institution of measures to prevent of AKI and acute renal failure (ARF) –
a. Urinary alkalization,
b. Mannitol,
c. Loop diuretics
3. Correction of electrolyte, acid-base, and metabolic abnormalities
4. Serial physical examinations and laboratory studies are indicated to monitor for:
a. Compartment syndrome,
b. Hyper-kalemia,
c. Acute oliguric or nonoliguric renal failure, and
d. Disseminated intravascular coagulation (DIC).
5. Compartment syndrome needs the immediate orthopedic consultation for fasciotomy.
6. DIC treated with:
a. Fresh frozen plasma,
b. Cryoprecipitate, and
c. Platelet transfusions
Surgical treatment:
Fasciotomy in compartment syndrome
Fracture treatment
Acute Kidney Injury and acute renal failure:
Hemodialysis

TABLE OF CONTENT
Introduction<

• Language: English
• Publisher: Kenneth Kee
• Release date: Aug 14, 2018
• ISBN: 9780463257739

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

Book preview

Rhabdomyolysis,

A

Simple

Guide

To

The Condition,

Diagnosis,

Treatment

And

Related Conditions

By

Dr Kenneth Kee

M.B.,B.S. (Singapore)

Ph.D (Healthcare Administration)

Copyright Kenneth Kee 2018 Smashwords Edition

Published by Kenneth Kee at Smashwords.com

Dedication

This book is dedicated

To my wife Dorothy

And my children

Carolyn, Grace

And Kelvin

This book describes Rhabdomyolysis, Diagnosis and Treatment and Related Diseases which is seen in some of my patients in my Family Clinic.

(What The patient Need to Treat Rhabdomyolysis)

This eBook is licensed for your personal enjoyment only. This eBook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader.

If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Smashwords.com and purchase your own copy.

Thank you for respecting the hard work of this author.

Introduction

I have been writing medical articles for my blog: http://kennethkee.blogspot.com (A Simple Guide to Medical Disorder) for the benefit of my patients since 2007.

My purpose in writing these simple guides was for the health education of my patients.

Health Education was also my dissertation for my Ph.D (Healthcare Administration).

I then wrote an autobiolographical account of his journey as a medical student to family doctor on his other blog: http://afamilydoctorstale.blogspot.com.

This autobiolographical account A Family Doctor’s Tale was combined with my early A Simple Guide to Medical Disorders into a new Wordpress Blog A Family Doctor’s Tale on http://kenkee481.wordpress.com.

From which many free articles from the blog was taken and put together into 800 eBooks.

Some people have complained that the simple guides are too simple.

For their information they are made simple in order to educate the patients.

The later books go into more details of medical disorders.

The first chapter is always from my earlier blogs which unfortunately tends to have typos and spelling mistakes.

Since 2013, I have tried to improve my spelling and writing.

As I tried to bring the patient the latest information about a disorder or illness by reading the latest journals both online and offline, I find that I am learning more and improving on my own medical knowledge in diagnosis and treatment for my patients.

Just by writing all these simple guides I find that I have learned a lot from your reviews (good or bad), criticism and advice.

I am sorry for the repetitions in these simple guides as the second chapters onwards have new information as compared to my first chapter taken from my blog.

I also find repetition definitely help me and maybe some readers to remember the facts in the books more easily.

I apologize if these repetitions are irritating to some readers.

Chapter 1

Rhabdomyolysis

What is Rhabdomyolysis?

Rhabdomyolysis is the decomposition (breakdown) of damaged skeletal muscle.

Muscle breakdown causes the discharge of myoglobin into the bloodstream.

Myoglobin is the protein that stocks up oxygen in the muscles.

If a person has too much myoglobin in the blood, it can cause kidney damage.

Most people with rhabdomyolysis are given fluids through their veins in an intravenous (IV) drip.

Some people may need dialysis or hemofiltration to treat kidney injury in more severe cases.

Rhabdomyolysis is a serious syndrome because of a direct or indirect muscle injury.

The injury produces the death of muscle fibers and passage of their contents into the bloodstream.

This can lead to serious complications such as kidney damage and failure.

This would indicate that the kidneys cannot remove waste and concentrated urine.

Infrequently, rhabdomyolysis can even cause death.

Prompt medical treatment often carries a good outcome.

What are the causes of Rhabdomyolysis?

Causes

When muscle is injured, a protein called myoglobin is secreted into the bloodstream.

It is then passed out of the body through filters in the kidneys.

Myoglobin decomposes into substances that can damage kidney cells.

Rhabdomyolysis may be caused by injury or any other disorder that injures skeletal muscle.

Disorders that may lead to this disease are:

1. Trauma or crush injuries

2. Use of drugs such as cocaine, amphetamines, statins, heroin, or PCP

3. Genetic muscle diseases

4. Extremes of body temperature

5. Ischemia or death of muscle tissue

6. Low phosphate levels

7. Seizures or muscle tremors

8. Severe exertion, such as marathon running or calisthenics

9. Prolonged surgical procedures

10. Severe dehydration

Risk Factors

Rhabdomyolysis is always precipitated by muscle injury.

This injury can have physical, chemical or genetic causes.

Anything that injures the muscles can produce this disorder:

1.